Lymphedema Therapy as An Area of Practice
I am a lymphedema "nerd." What that means is that I love working as a lymphedema therapist and I love reading about it, and learning more about it, and discussing the work with my peers.
My area of practice in my work as an OT is with people who have Lymphedema. Lymphedema is a chronic disease that we didn't learn about in college. It requires further continuing education to learn how to work in it, and it's an area of therapy that I was drawn to the minute I heard about it years after my graduation as an OT.
I was drawn to work with breast cancer survivors who developed lymphedema. I then went on to learn that the treatment of lymphedema covered more areas than the problem of lymphedema from breast cancer. There are many occupational and physical therapists who are quite busy with a caseload of patients who enthusiastically want to have a treatment that is so non-invasive and really helps them to live with this chronic disease!
From what I have gleaned at the many continuing education conferences I have attended, the gold standard for lymphedema is CDT, or Complex Decongestive Therapy. This is a combination of manual lymphatic drainage, compression bandaging, exercise while bandaged, compression garments and meticulous skin care.
What is lymphedema?
Lymphedema is actually an accumulation of a protein rich fluid in a body part such as an arm or leg; this protein rich lymph fluid can cause inflammation. If left untreated, the inflammation will cause fibrotic changes in the tissue. It differs from most other occurrences of swelling by the protein rich nature of the edema.
Most people have heard of lymphedema as a side effect from cancer treatment, in particular when the treatment consists of removing lymph nodes (which will help the oncologist to stage the cancer and determine treatment options). Radiation can also increase the risk. No one knows who or why an individual will develop lymphedema.
Lymphedema that develops after cancer treatment is called secondary lymphedema. There are some guidelines to follow for patients at risk for developing secondary lymphedema from cancer treatment. It is helpful to care for the area of the body that could possibly be affected by these lifesaving cancer treatments. For instance, blood pressure cuffs are not used on arms where the lymph nodes were removed, as a precaution.
Another form of secondary lymphedema is caused by an infection called filariasis. This can occur in the tropical areas of the world caused by a mosquito born parasite; rather uncommon in the United States, the treatment would be the same.
There is also primary lymphedema, which has a genetic or congenital component. To put it in very simple terms, primary lymphedema is caused a mechanical insufficiency of the lymphatic system. Examples of possible problems are that there not enough lymph collectors in the affected area, vessels could be less functional, there could be an absence of lymph collectors or there may be other problems with the way the system functions.
I could go on and on talking about this. There are other causes of secondary lymphedema, and there are also other diagnoses that are combination types, such as chronic venous insufficiency and a resulting lymphedema, and obesity and lymphedema. Both of those combination types can be treated with the compression bandages and compression garments.
I find this work to be exactly what I want to be doing in OT. It consists of constant ongoing learning and adaptation of the fundamental treatment principles to be helpful to the patient and his or her unique needs. The work is done individually with patients and the patient is an active participant in the therapy, or if he or she is unable a family member may be the helper. The patient will benefit greatly with "proactive" participation.
Another great aspect of treatment, also very proactive, is the use of diaphragmatic breathing, which is my most all-time favorite aspect of self-care ever!
Go ahead.
Call me a lymphedema nerd. That is okay with me.
I would love to hear from you. Are you working in an unusual area of practice that you never trained for in college?
Until next time,
Lorraine